Job Application New

www.communityaccesstransportation.com

Community Access Inc is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from

consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation inthe application process, he or she should contact a company representative.

Please fill out all of the sections below:
Applicant Name
Address

Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Telephone Number
Email Address
example@example.com
Date of Application

MonthDayYear
Date
Position(s) applying for: Driving
How did you hear about this position?
What days are you available for work?
What hours or shift are you available for work?
If needed, are you available to work overtime?
On what date can you start working if you are hired?

MonthDayYear
Date
Do you have reliable transportation to and from work?
Have you ever applied to or worked for Community Access Inc before?
Yes
No
If yes, when?
Are you 18 years of age or older?
Yes
No
Are you a U.S. citizen or approved to work in the United States?
Yes
No
What document can you provide as proof of citizenship or legal status?
Will you consent to a mandatory controlled substance test?
Yes
No
Have you ever been convicted of a criminal offense (felony or misdemeanor)?
Yes
No
If yes, please state the nature of the crime(s), when and where convicted and disposition of the case
(Note: No applicant will be denied employment solely on thegrounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered
Please list below the skills and qualifications you possess for the position for which you are applying
(Note: Community Access Inc complies with the ADA and considers reasonable accommodation measures that maybenecessaryforeligibleapplicants/employeestoperform essentialfunctions.,
Education and Training
Name
Location (City, State)
Year Graduated
Degree Earned
Name
Location (City, State)
Year Graduated
Degree Earned
Vocational School/Specialized Training
Name
Location (City, State)
Year Graduated
Degree Earned
Military
Are you a member of the Armed Services?
What branch of the military did you enlist?
What was your military rank when discharged?
How many years did you serve in the military?
What military skills do you possess that would be an asset for this position?
Previous Employment
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Employer Telephone
Dates Employed

MonthDayYear
Date
Reason for leaving
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Employer Telephone
Dates Employed

MonthDayYear
Date
Reason for leaving
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Employer Telephone
Dates Employed

MonthDayYear
Date
Reason for leaving
Please provide 3 personal and professional reference(s) below:
Reference
Reference
Reference
Additional Information
Is your driving record free and clear of any traffic infractions or accidents? If not where and when did they occur? (This does not necessarily negate you from the position)
Do you speak any other languages? If so what?
Have you ever lived in another state or country? If so where and when?
Are you currently first aid/Cpr certified? If so when is the expiration?
At Will Employment
The relationship between you and the Community Access Inc is referred to as "employment at will.' This means that your employment can be

terminated at any time for any reason, with or without cause, with or without notice, by you or the Community Access Inc. No representative of

Community Access Inc has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand

that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment

can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations

Officer or the Company's President.
Applicant Signature

Clear
Dated

MonthDayYear
Date
This is a fill in the blanks field. Please add appropriate blank fields and text.
Should be Empty:

Education and Training

Military

Previous Employment

Additional Information

At Will Employment